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General NPI Number Information
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NPI Number | 1417133448
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Entity Type | Organization
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Legal Business Name | WELLSPAN MEDICAL GROUP
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 09/25/2017
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Provider Practice Location Address
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Address Line | 435 S KINZER AVE
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City | NEW HOLLAND
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State | PA
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Zip | 17557-8706
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Country | US
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Telephone | 717-351-2419
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Fax | 717-351-2422
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Provider Business Mailing Address
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Address Line | 3421 CONCORD RD
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City | YORK
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State | PA
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Zip | 17402-9001
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Country | US
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Telephone | 717-851-1405
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | JOHN A HOLMES
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Credential | CFO
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Telephone | 717-738-6845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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